Imaging Science in Dentistry

Korean Academy of Oral and Maxillofacial Radiology (대한영상치의학회)
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Sonographic assessment of carotid intima-media thickness in healthy young Thai adults

  • Received : 2023.01.27
  • Accepted : 2023.07.14
  • Published : 2023.12.31
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Abstract

Purpose: Early detection of carotid stenosis can reduce cardiovascular risk. In this study, the maximum-carotid intima-media thickness (CIMT), the mean-CIMT, and the presence of plaque were examined in healthy young Thai adults. Additionally, correlations between CIMT and cardiovascular risk factors were assessed. Materials and Methods: Left and right carotid arteries of 302 participants(15-45 years old) were scanned, with CIMT measured at the far walls of the common carotid artery, carotid bulb, and internal carotid artery. Demographics and risk factors were assessed using a questionnaire. Ten random participants were re-scanned after 4 weeks. Results: The study included 123 (40.70%) male and 179 (59.30%) female participants. The max-CIMT, mean-CIMT, and plaque thickness were 0.400±0.100, 0.403±0.095 and 1.520±0.814 mm, respectively. Male participants had significantly higher CIMT values for nearly all locations and age groups. The right-sided CIMT values were higher for all locations. The carotid bulb had the greatest CIMT values(0.437±0.178 mm), followed by the common (0.403±0.095 mm) and internal(0.361±0.099 mm) carotid arteries. Plaque was present in 18 locations (1.00%), affecting 15 participants (4.97%). These plaques were found in the right carotid bulb (n=9; 0.50%), left carotid bulb (n=7; 0.39%), and right internal carotid artery (n=2; 0.11%). Adjusted multivariable regression revealed significant positive associations between CIMT and male, increased age and "other" occupation (P<0.05). Conclusion: Both max-CIMT and mean-CIMT were approximately 0.4 mm. Plaque was observed in 4.97% of patients, with an average thickness of 1.5 mm. The most influential risk factors for increased CIMT were sex, age, and occupation.

Keywords

Acknowledgement

The authors would like to express their gratitude to Assistant Professor Dr. Soranun Chantarangsu for her kind support and contributions to statistical matters.

References

  1. Charles W. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet 1991; 337: 1235-43. https://doi.org/10.1016/0140-6736(91)92916-P
  2. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115: 459-67. https://doi.org/10.1161/CIRCULATIONAHA.106.628875
  3. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Boehm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Press 2013; 22: 193-278.
  4. Terminology and Diagnostic Criteria Committee, Japan Society of Ultrasonics in Medicine. Standard method for ultrasound evaluation of carotid artery lesions. J Med Ultrason 2009; 36: 219-26. https://doi.org/10.1007/s10396-009-0238-y
  5. Wada S, Koga M, Toyoda K, Minematsu K, Yasaka M, Nagai Y, et al. Factors associated with intima-media complex thickness of the common carotid artery in Japanese noncardioembolic stroke patients with hyperlipidemia: The J-STARS echo study. J Atheroscler Thromb 2018; 25: 359-73. https://doi.org/10.5551/jat.41533
  6. Bond MG, Barnes RW, Riley WA, Wilmoth SK, Chambless LE, Howard G, et al. High-resolution B-mode ultrasound scanning methods in the Atherosclerosis Risk in Communities study (ARIC). J Neuroimaging 1991; 1: 68-73. https://doi.org/10.1111/jon19911268
  7. LeFevre ML, US Preventive Services Task Force. Screening for asymptomatic carotid artery stenosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161: 356-62. https://doi.org/10.7326/M14-1333
  8. Bloetzer C, Bovet P, Suris JC, Simeoni U, Paradis G, Chiolero A. Screening for cardiovascular disease risk factors beginning in childhood. Public Health Rev 2015; 36: 9.
  9. Gray VL, Goldberg AP, Rogers MW, Anthony L, Terrin ML, Guralnik JM, et al. Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults. J Vasc Surg 2020; 71: 1930-7. https://doi.org/10.1016/j.jvs.2019.09.020
  10. Goeggel Simonetti B, Mono ML, Huynh-Do U, Michel P, Odier C, Sztajzel R, et al. Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS). J Neurol 2015; 262: 2025-32. https://doi.org/10.1007/s00415-015-7805-5
  11. Oikonen M, Laitinen TT, Magnussen CG, Steinberger J, Sinaiko AR, Dwyer T, et al. Ideal cardiovascular health in young adult populations from the United States, Finland, and Australia and Its association with cIMT: the International Childhood Cardiovascular Cohort Consortium. J Am Heart Assoc 2013; 2: e000244.
  12. Dawson JD, Sonka M, Blecha MB, Lin W, Davis PH. Risk factors associated with aortic and carotid intima-media thickness in adolescents and young adults: the Muscatine Offspring Study. J Am Coll Cardiol 2009; 53: 2273-9. https://doi.org/10.1016/j.jacc.2009.03.026
  13. Tzou WS, Douglas PS, Srinivasan SR, Bond MG, Tang R, Li S, et al. Distribution and predictors of carotid intima-media thickness in young adults. Prev Cardiol 2007; 10: 181-9. https://doi.org/10.1111/j.1520-037X.2007.06450.x
  14. Davis PH, Dawson JD, Riley WA, Lauer RM. Carotid intimal-medial thickness is related to cardiovascular risk factors measured from childhood through middle age: the Muscatine study. Circulation 2001; 104: 2815-9. https://doi.org/10.1161/hc4601.099486
  15. Johnson HM, Douglas PS, Srinivasan SR, Bond MG, Tang R, Li S, et al. Predictors of carotid intima-media thickness progression in young adults: the Bogalusa Heart Study. Stroke 2007; 38: 900-5. https://doi.org/10.1161/01.STR.0000258003.31194.0a
  16. Chiesa ST, Charakida M, Georgiopoulos G, Dangardt F, Wade KH, Rapala A, et al. Determinants of intima-media thickness in the young: the ALSPAC Study. JACC Cardiovasc Imaging 2021; 14: 468-78. https://doi.org/10.1016/j.jcmg.2019.08.026
  17. Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991.
  18. Razi SM, Manish G, Keshav GK, Sukriti K, Gupta A. Site or size of waist circumference, which one is more important in metabolic syndrome? Int J Med Public Health 2016; 6: 69-72. https://doi.org/10.5530/ijmedph.2016.2.4
  19. Fink B. Neck circumference: its usage in medicine and biology. In: Preedy VR. Handbook of anthropometry. New York: Springer; 2012. p. 665-75.
  20. World Health Organization. Waist circumference and waist-hip ratio report of a WHO expert consultation. Geneva, 8-11 December 2008. Geneva: WHO Press; 2011.
  21. Bushman BA. Physical activity guidelines for Americans: the relationship between physical activity and health. ACSM'S Health Fit J 2019; 23: 5-9. https://doi.org/10.1249/FIT.0000000000000472
  22. Juonala M, Kahonen M, Laitinen T, Hutri-Kahonen N, Jokinen E, Taittonen L, et al. Effect of age and sex on carotid intima-media thickness, elasticity and brachial endothelial function in healthy adults: the cardiovascular risk in Young Finns Study. Eur Heart J 2008; 29: 1198-206. https://doi.org/10.1093/eurheartj/ehm556
  23. de Weerd M, Greving JP, de Jong AW, Buskens E, Bots ML. Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis. Stroke 2009; 40: 1105-13. https://doi.org/10.1161/STROKEAHA.108.532218
  24. Loboz-Rudnicka M, Jaroch J, Bociaga Z, Rzyczkowska B, Uchmanowicz I, Polanski J, et al. Impact of cardiovascular risk factors on carotid intima-media thickness: sex differences. Clin Interv Aging 2016; 11: 721-31.
  25. Luo X, Yang Y, Cao T, Li Z. Differences in left and right carotid intima-media thickness and the associated risk factors. Clin Radiol 2011; 66: 393-8. https://doi.org/10.1016/j.crad.2010.12.002
  26. Bruno RM, Artom N, Colapietro N, De Feo M, Di Pilla M, Geraci G, et al. Socio-economic and lifestyle determinants of carotid stiffness in young adults: the Igame Study. J Hypertens 2019; 37: e146.
  27. Centers for Disease Control and Prevention [Internet]. Youth and tobacco use. Atlanta: Centers of Disease Control and Prevention [updated 2022 Nov 10; cited 2023 May 9]. Available from: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm
  28. Shu D, Chen F, Zhang C, Guo W, Dai S. Environmental tobacco smoke and carotid intima-media thickness in healthy children and adolescents: a systematic review. Open Heart 2022; 9: e001790.
  29. Jee Y, Jung KJ, Lee S, Back JH, Jee SH, Cho SI. Smoking and atherosclerotic cardiovascular disease risk in young men: the Korean Life Course Health Study. BMJ Open 2019; 9: e024453.
  30. Ayer JG, Belousova E, Harmer JA, David C, Marks GB, Celermajer DS. Maternal cigarette smoking is associated with reduced high-density lipoprotein cholesterol in healthy 8-year-old children. Eur Heart J 2011; 32: 2446-53. https://doi.org/10.1093/eurheartj/ehr174
  31. O'Keefe JH, Bybee KA, Lavie CJ. Alcohol and cardiovascular health: the razor-sharp double-edged sword. J Am Coll Cardiol 2007; 50: 1009-14. https://doi.org/10.1016/j.jacc.2007.04.089
  32. Juonala M, Viikari JS, Kahonen M, Laitinen T, Taittonen L, Loo BM, et al. Alcohol consumption is directly associated with carotid intima-media thickness in Finnish young adults: the Cardiovascular Risk in Young Finns Study. Atherosclerosis 2009; 204: e93-8. https://doi.org/10.1016/j.atherosclerosis.2008.11.021
  33. Freedman DS, Patel DA, Srinivasan SR, Chen W, Tang R, Bond MG, et al. The contribution of childhood obesity to adult carotid intima-media thickness: the Bogalusa Heart Study. Int J Obes (Lond) 2008; 32: 749-56. https://doi.org/10.1038/sj.ijo.0803798
  34. Lozano P, Henrikson NB, Morrison CC, Dunn J, Nguyen M, Blasi PR, et al. Lipid screening in childhood and adolescence for detection of multifactorial dyslipidemia: evidence report and systematic review for the US preventive services task force. JAMA. 2016; 316: 634-44. https://doi.org/10.1001/jama.2016.6423
  35. Neuhauser HK, Buschges J, Schaffrath Rosario A, Schienkiewitz A, Sarganas G, Konigstein K, et al. Carotid intima-media thickness percentiles in adolescence and young adulthood and their association with obesity and hypertensive blood pressure in a population cohort. Hypertension 2022; 79: 1167-76. https://doi.org/10.1161/HYPERTENSIONAHA.121.18521
  36. Del Brutto OH, Mera RM, Nader JA, Zambrano M, Castillo PR, Matcha G, et al. The relationship between the neck circumference and the carotid intima-media thickness in Amerindians: potential links to health risks? Pathophysiology 2018; 25: 427-31. https://doi.org/10.1016/j.pathophys.2018.08.007
  37. Jourdan C, Wuhl E, Litwin M, Fahr K, Trelewicz J, Jobs K, et al. Normative values for intima-media thickness and distensibility of large arteries in healthy adolescents. J Hypertens 2005; 23: 1707-15. https://doi.org/10.1097/01.hjh.0000178834.26353.d5
  38. Pahkala K, Heinonen OJ, Simell O, Viikari JS, Ronnemaa T, Niinikoski H, et al. Association of physical activity with vascular endothelial function and intima-media thickness. Circulation 2011; 124: 1956-63. https://doi.org/10.1161/CIRCULATIONAHA.111.043851
  39. Konigstein K, Buschges JC, Sarganas G, Krug S, Neuhauser H, Schmidt-Trucksass A. Exercise and carotid properties in the young - the KiGGS-2 Study. Front Cardiovasc Med 2022; 8: 767025.
  40. Liu RS, Dunn S, Grobler AC, Lange K, Becker D, Goldsmith G, et al. Carotid artery intima-media thickness, distensibility and elasticity: population epidemiology and concordance in Australian children aged 11-12 years old and their parents. BMJ Open 2019; 9(Suppl 3): 23-33. https://doi.org/10.1136/bmjopen-2017-020264